EffectivenessoftherapeuticsandhealthcareservicesinreducingracialdisparitiesinAlzheimer's disease(PI:Zissimopoulos) ProjectSummary TheoriginsofracialdisparitiesinAlzheimer'sdiseasearemultifacetedrangingfromriskofAD,toaccess tocare,todeliveryofcare,togeneticvarianceinresponsetocare.Intheproposedprogramofresearch, wewillapproachthechallengeofracialandethnicdisparitiesinAlzheimer'sdisease(AD)fromtwo perspectives:useofandresponsetodrugtherapiesfornon?ADconditionsthatinfluenceriskofADand; healthcaretreatmentsforAD.Ourgoalsaretoidentifyracialandethnicdifferencesinbothand,once identified,elucidateopportunitiesforpotentialADpreventionandtreatmentregimensacrossdiverse populations.Toachievethesegoals,wewillconductanalysesusinglongitudinalMedicareclaimsdata onover10millionpersonsperyear.Medicareclaimsdatahaveseveraladvantagesoverothertypesof datasuchasclinicaltrialdata,surveydataordatafromelectronicmedicalrecords:1)Medicare beneficiariesareoftheagegroupatgreatestriskforAD,personsages65orolder,beneficiariesareof bothsexesandallracesandcomefromdiversesocioeconomicbackgrounds;2)themagnitudeofthe Medicarepopulationprovidessufficientnumberofpersonsbysexandbyracetoconductstatically poweredanalyses;3)datacontaindetailsonallprescribeddrugtherapiesandhealthcaretreatments andservicesreimbursedbyMedicareandtheyarenotlimitedbyerrorinself?reportmeasurescommon insurveydata.Aim1willidentifydrugtherapiescurrentlyusedtotreatnon?ADconditionsthatmay affectADrisk.Expertpanelistswillhelpprioritizetheevidenceandprovideinsightintoprobable variationsacrosssex,raceandethnicity.Aim2willanalyzetheinfluenceofthesedrugtreatmentson incidenceofADanddifferencesintheassociationacrosssex,raceandethnicity.Aim3willevaluate racialdisparitiesinADdiagnosesandtreatmentsovertime,includingdiagnosismethods;thespecialties ofdiagnosingphysicians;initiationanduseofADandotherpsychotropicdrugs;timingandregularityof physicianvisits;andthefactorsassociatedwithdifferencesacrossdiverseraceandethnicpopulations. Thisresearchwillinformdrugtargetsandthedesignofclinicaltrials,aswellasADtreatmentandcare interventionstoreduceracialdisparitiesincombatingthedisease.